Provider Demographics
NPI:1336132034
Name:ARNETT, JASON W (PA)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:W
Last Name:ARNETT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30010N 59TH ST
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-3022
Mailing Address - Country:US
Mailing Address - Phone:480-828-4250
Mailing Address - Fax:
Practice Address - Street 1:20950 N TATUM BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4200
Practice Address - Country:US
Practice Address - Phone:480-502-6651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2475363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00662145OtherMEDICARE RAILROAD/ DERMATOLOGY VEIN AND LASER
AZP00633844OtherRAILROAD MEDICARE WEST DERM OF AZ
AZP00809245OtherRR MEDICARE FOR GROUP PTAN#DP3049
AZS92095Medicare UPIN
AZP00809245OtherRR MEDICARE FOR GROUP PTAN#DP3049
AZZ131629Medicare PIN